| NPI | 1043257959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301088907) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35081878) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2020-03-30 |